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Less-invasive surgery tied to less cost, absenteeism

By Genevra Pittman

NEW YORK (Reuters Health) - Minimally-invasive forms of heart surgery and fibroid removal may be less expensive - and cause patients to take fewer days off from work - than standard versions of the same procedures, a new study suggests.

Researchers looking at six common surgeries found that if every one of them performed in the U.S. in 2009 had used minimally-invasive techniques, health plans would have saved $2.3 billion and employees would have missed about 20,000 fewer days of work.

The researchers pointed out, however, that not all surgeries can be done with smaller incisions. And they didn't have data on how patients fared after standard versus less-invasive procedures.

"We're not saying everyone should get minimally-invasive surgery," said Andrew Epstein, who led the study at the University of Pennsylvania's Perelman School of Medicine in Philadelphia.

"What we are saying, I think, is that at least for these procedures, we've demonstrated there's this other dimension of potential value associated with minimally-invasive procedures," he told Reuters Health.

"At the end of the day, it's still, ‘Talk to your physician and decide what's right.'"

Epstein and his colleagues analyzed insurance claims from 322,000 young and middle-aged adults undergoing one of six surgeries in 2001 through 2008. Those included heart and vascular surgeries as well as uterine fibroid treatments and prostate removals.

About 60 percent of surgeries were done using minimally-invasive techniques. For three of the procedures - two types of cardiovascular surgery, including stent insertion, and fibroid resection - the less-invasive versions were cheaper by $1,500 to $31,000 each.

Two other surgeries, including prostate removal and stroke-preventing procedures, were more expensive when done less invasively.

Among 24,000 employees with absenteeism data who had surgery, four of the six procedures led to an average of between nine and 38 fewer missed days of work than traditional options, the researchers reported Wednesday in JAMA Surgery.

Those findings held after they took the patients' age, gender and general health into account.

"I don't think the results are shocking, at least in the sense of showing that people with minimally-invasive procedures miss less work," Epstein said. That's consistent with research showing patients have shorter hospital stays following less-invasive procedures, he added.

"From a patient's perspective, whenever you undergo a surgery, you want to get back to your normal life and normal function as fast as you can," said Dr. Jason Wright, a gynecologic surgeon at Columbia University Medical Center in New York.

Still, he added, there's a need for more research on the long-term outcomes of many types of minimally-invasive surgery. And those outcomes may not look the same for every person.

"It's really important for patients, whenever they have a surgery, that they need to sit down and talk with their doctors…about the efficacy of the procedure," Wright, who wasn't involved in the new research, told Reuters Health.

"Each one of these really needs to be individualized," he said. "Patients really need to be aware of their options."

SOURCE: http://bit.ly/JLp3jy JAMA Surgery, online March 20, 2013.

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